(±)-4-Amino-3-(4-chlorophenyl)butanoic acid (baclofen), (1), is an analog of gamma-aminobutyric acid (i.e., GABA) that selectively activates GABAB receptors, resulting in neuronal hyperpolarization. GABAB receptors are located in laminae I-IV of the spinal cord, where primary sensory fibers end. These G-protein coupled receptors activate conductance by K+-selective ion channels and can reduce currents mediated by Ca2+ channels in certain neurons. Baclofen has a presynaptic inhibitory effect on the release of excitatory neurotransmitters and also acts postsynaptically to decrease motor neuron firing (see Bowery, Trends Pharmacol. Sci. 1989, 10, 401-407; Misgeld et al., Prog. Neurobiol. 1995, 46, 423-462).

Many examples of compounds having agonistic or partially agonistic affinity to GABAB receptors exist and include certain amino acids, aminophosphonic acids, aminophosphinic acids, aminophosphonous acids and aminosulfinic acids such as, for example,    4-amino-3-(2-chlorophenyl)butanoic acid;    4-amino-3-(4-fluorophenyl)butanoic acid;    4-amino-3-hydroxybutanoic acid;    4-amino-3-(4-chlorophenyl)-3-hydroxyphenylbutanoic acid;    4-amino-3-(thien-2-yl)butanoic acid;    4-amino-3-(5-chlorothien-2-yl)butanoic acid;    4-amino-3-(5-bromothien-2-yl)butanoic acid;    4-amino-3-(5-methylthien-2-yl)butanoic acid;    4-amino-3-(2-imidazolyl)butanoic acid;    4-guanidino-3-(4-chlorophenyl)butanoic acid;    (3-aminopropyl)phosphonous acid;    (4-aminobut-2-yl)phosphonous acid;    (3-amino-2-methylpropyl)phosphonous acid;    (3-aminobutyl)phosphonous acid;    (3-amino-2-(4-chlorophenyl)propyl)phosphonous acid;    (3-amino-2-(4-chlorophenyl)-2-hydroxypropyl)phosphonous acid;    (3-amino-2-(4-fluorophenyl)propyl)phosphonous acid;    (3-amino-2-phenylpropyl)phosphonous acid;    (3-amino-2-hydroxypropyl)phosphonous acid;    (E)-(3-aminopropen-1-yl)phosphonous acid;    (3-amino-2-cyclohexylpropyl)phosphonous acid;    (3-amino-2-benzylpropyl)phosphonous acid;    [3-amino-2-(4-methylphenyl)propyl]phosphonous acid;    [3-amino-2-(4-trifluoromethylphenyl)propyl]phosphonous acid;    [3-amino-2-(4-methoxyphenyl)propyl]phosphonous acid;    [3-amino-2-(4-chlorophenyl)-2-hydroxypropyl]phosphonous acid;    (3-aminopropyl)methylphosphinic acid;    (3-amino-2-hydroxypropyl)methylphosphinic acid;    (3-aminopropyl)(difluoromethyl)phosphinic acid;    (4-aminobut-2-yl)methylphosphinic acid;    (3-amino-1-hydroxypropyl)methylphosphinic acid;    (3-amino-2-hydroxypropyl)(difluoromethyl)phosphinic acid;    (E)-(3-aminopropen-1-yl)methylphosphinic acid;    (3-amino-2-oxo-propyl)methyl phosphinic acid;    (3-aminopropyl)hydroxymethylphosphinic acid;    (5-aminopent-3-yl)methylphosphinic acid;    (4-amino-1,1,1-trifluorobut-2-yl)methylphosphinic acid;    3-aminopropylsulfinic acid;    (3-amino-2-(4-chlorophenyl)propyl)sulfinic acid;    (3-amino-2-hydroxypropyl)sulfinic acid;    (2S)-(3-amino-2-hydroxypropyl)sulfinic acid;    (2R)-(3-amino-2-hydroxypropyl)sulfinic acid;    (3-amino-2-fluoropropyl)sulfinic acid;    (2S)-(3-amino-2-fluoropropyl)sulfinic acid;    (2R)-(3-amino-2-fluoropropyl)sulfinic acid; and    (3-amino-2-oxopropyl)sulfinic acid.
A principal pharmacological effect of baclofen in mammals is reduction of muscle tone and the drug is frequently used in the treatment of spasticity. Spasticity is associated with damage to the corticospinal tract and is a common complication of neurological disease. Diseases and conditions in which spasticity may be a prominent symptom include cerebral palsy, multiple sclerosis, stroke, head and spinal cord injuries, traumatic brain injury, anoxia and neurodegenerative diseases. Patients with spasticity complain of stiffness, involuntary spasm and pain. These painful spasms may be spontaneous or triggered by a minor sensory stimulus, such as touching the patient.
Baclofen is useful in controlling gastro-esophageal reflux disease (van Herwaarden et al., Aliment. Pharmacol. Ther. 2002, 16, 1655-1662; Ciccaglione et al., Gut 2003, 52, 464-470; Andrews et al., U.S. Pat. No. 6,117,908; Fara et al., International Publication No. WO02/096404); in promoting alcohol abstinence in alcoholics (Gessa et al., International Publication No. WO01/26638); in promoting smoking cessation (Gessa et al., International Publication No. WO01/08675); in reducing addiction liability of narcotic agents (Robson et al., U.S. Pat. No. 4,126,684); in the treatment of emesis (Bountra et al., U.S. Pat. No. 5,719,185) and as an anti-tussive for the treatment of cough (Kreutner et al., U.S. Pat. No. 5,006,560).
Baclofen may be administered orally or by intrathecal delivery through a surgically implanted programmable pump. The drug is rapidly absorbed from the gastrointestinal tract and has an elimination half-life of approximately 3-4 hours. Baclofen is partially metabolized in the liver but is largely excreted by the kidneys unchanged. The short half-life of baclofen necessitates frequent administration with typical oral dosing regimens ranging from about 10 to about 80 mg of three or four divided doses daily. Plasma baclofen concentrations of about 80 to about 400 ng/mL result from these therapeutically effective doses in patients (Katz, Am. J. Phys. Med. Rehabil. 1988, 2, 108-116; Krach, J Child Neurol. 2001, 16, 31-36). When baclofen is given orally, sedation is a side effect, particularly at elevated doses. Impairment of cognitive function, confusion, memory loss, dizziness, weakness, ataxia and orthostatic hypotension are other commonly encountered baclofen side-effects.
Intrathecal administration is often recommended for patients who find the adverse effects of oral baclofen intolerable. The intrathecal use of baclofen permits effective treatment of spasticity with doses less than 1/100th of those required orally, since administration directly into the spinal subarachnoid space permits immediate access to the GABAB receptor sites in the dorsal horn of the spinal cord. Surgical implantation of a pump is, however, inconvenient and a variety of mechanical and medical complications can arise (e.g., catheter displacement, kinking or blockage, pump failure, sepsis and deep vein thrombosis). Acute discontinuation of baclofen therapy (e.g., in cases of mechanical failure) may cause serious withdrawal symptoms such as hallucinations, confusion, agitation and seizures (Sampathkumar et al., Anesth. Analg. 1998, 87, 562-563).
While the clinically prescribed baclofen product (Lioresal™) is available only as a racemate, the GABAB receptor agonist activity resides entirely in one enantiomer, R-(−)-baclofen (2) (also termed L-baclofen).

The other isomer, S-baclofen, actually antagonizes the action of R-baclofen at GABAB receptors and its antinociceptive activity in the rat spinal cord (Terrence et al., Pharmacology 1983, 27, 85-94; Sawynok et al. Pharmacology 1985, 31, 248-259). Orally administered R-baclofen is reported to be about 5-fold more potent than orally administered racemic baclofen, with an R-baclofen regimen of 2 mg t.i.d being equivalent to racemic baclofen at 10 mg t.i.d. (Fromm et al., Neurology 1987, 37, 1725-1728). Moreover, the side effect profile, following administration of R-baclofen, has been shown to be significantly reduced, relative to equally efficacious dose of racemic baclofen.
Baclofen, a zwitterionic amino acid, lacks the requisite physicochemical characteristics for effective passive permeability across cellular membranes. Passage of the drug across the gastrointestinal tract and the blood-brain barrier (BBB) are mediated primarily by active transport processes, rather than by passive diffusion. Accordingly, baclofen is a substrate for active transport mechanisms shared by neutral α-amino acids like leucine, and β-amino acids like β-alanine and taurine (van Bree et al., Pharm. Res. 1988, 5, 369-371; Cercos-Fortea et al., Biopharm. Drug. Disp. 1995, 16, 563-577; Deguchi et al., Pharm. Res. 1995, 12, 1838-1844; Moll-Navarro et al., J. Pharm. Sci. 1996, 85, 1248-1254). Transport across the BBB is stereoselective, with preferential uptake of the active R-enantiomer (2) being reported (van Bree et al., Pharm. Res. 1991, 8, 259-262). In addition, organic anion transporters localized in capillary endothelial cells of the blood-brain barrier have been implicated in efflux of baclofen from the brain (Deguchi et al., supra; Ohtsuki et al., J. Neurochem. 2002, 83, 57-66). 3-(p-Chlorophenyl)pyrrolidine has been described as a CNS-penetrable prodrug of baclofen (Wall et al., J. Med. Chem. 1989, 32, 1340-1348). Prodrugs of other GABA analogs are described in Bryans et al., International Publication No. WO01/90052; Bryans et al., EP1178034; Cundy et al., U.S. Patent Application Publication No. 2002/0151529; Gallop et al., U.S. Patent Application Publication No. 2003/0176398; Gallop et al., U.S. Patent Application Publication No. 2003/0171303; Gallop et al., U.S. Patent Application Publication No. 2004/0006132; and Raillard et al., U.S. Patent Application Publication No. 2004/0014940.
Sustained released oral dosage formulations are a conventional solution to the problem of rapid systemic drug clearance, as is well known in the art (see, e.g., “Remington's Pharmaceutical Sciences,” Philadelphia College of Pharmacy and Science, 19th Edition, 1995). Osmotic delivery systems are also recognized methods for sustained drug delivery (See, e.g., Verma et al., Drug Dev. Ind. Pharm. 2000, 26, 695-708). Successful application of these technologies depends on the drug of interest having an effective level of absorption from the large intestine (also referred to herein as the colon), where the dosage form spends a majority of its time during its passage down the gastrointestinal tract. Baclofen is poorly absorbed following administration into the colon in animal models (Merino et al., Biopharm. Drug. Disp. 1989, 10, 279-297), presumably, since the transporter proteins mediating baclofen absorption in the upper region of the small intestine are not expressed in the large intestine. Development of an oral controlled release formulation for baclofen should considerably improve the convenience, efficacy and side effect profile of baclofen therapy. However, the rapid passage of conventional dosage forms through the proximal absorptive region of the small intestine has thus far prevented the successful application of sustained release technologies to this drug. A number of exploratory delivery technologies that rely on either mucoadhesion or gastric retention have been suggested to achieve sustained delivery of baclofen (Sinnreich, U.S. Pat. No. 4,996,058; Khanna, U.S. Pat. No. 5,091,184; Fara et al., supra; Dudhara et al., International Publication No. WO03/011255) though to date none of these appear to be able to achieve sustain blood levels of baclofen in human subjects.
Thus, there is a significant need for new prodrugs of baclofen and baclofen analogs which are well absorbed in the large intestine/colon and hence suitable for oral sustained release formulations, thus improving the convenience, efficacy and side effect profile of baclofen therapy.